Primary biliary tract malignancies: MRI spectrum and mimics with histopathological correlation

Abstract

Contrast-enhanced magnetic resonance imaging and magnetic resonance cholangiopancreatography (MRCP), due to their excellent soft tissue contrasts, have become first-line noninvasive tests in the characterization and detection of both hepatic and pancreaticobiliary pathologies. MRCP is also helpful in detecting the level and cause of obstruction in patients presenting with jaundice. Cholangiocarcinoma (CCA) is the most common primary malignant tumor arising from the bile duct epithelium, with extrahepatic tumors presenting more often than with intrahepatic ones. However, the diagnosis and management of CCA is made more complex by a variety of malignant and benign conditions that resemble CCA, including hepatocellular carcinoma variants such as the fibrolamellar variant of hepatocellular carcinoma, cholangiocellular carcinoma, biliary metastases, hepatic inflammatory pseudotumor, lymphoepithelioma-like carcinoma, confluent fibrosis, primary sclerosis cholangitis, and the secondary sclerosing cholangitis complex. Consequently, knowledge of the underlying risk factors and imaging characteristics of these conditions is important in differentiating between neoplastic and non-neoplastic conditions in order to reach a definite diagnosis. Endoscopic retrograde cholangiopancreatography should be reserved for those patients who require intervention or biopsy for histopathological diagnosis.

Diagnostic accuracy of magnetic resonance, computed tomography and contrast enhanced ultrasound in radiological multimodality assessment of peribiliary liver metastases

“…Although ultrasound (US) is sometimes the first modality used in the evaluation of biliary tract disease, the accuracy of US varies according to patient body habitus and the operator skill [5]. US is not accurate in the estimation of tumor spread and in the determination of tumor resectability compared to CT or MRI [6–7]. CT and MRI are a comprehensive imaging modality with multiplanar capability to assess the liver parenchyma and biliary tree.…”

“…MRI provides an assessment of the signal characteristics, vascularity, and pathophysiology of different tumors due to its superior soft-tissue contrast [8–9]. Given that this information is crucial for tumor staging and treatment planning, MRI is the preferred imaging modality for patients with suspected biliary tumors [6]. The purpose of this study was to compare the diagnostic performance of MDCT, US without and with contrast medium (CEUS) and MRI in patients with proven peribiliary metastases..…”

Magnetic Resonance Imaging of Primary Hepatic Malignancies in Patients With and Without Chronic Liver Disease: A Pictorial Review

“…This pattern should not be mischaracterized as a hemangioma because of the progressive nature. Other patterns include early peripheral enhancement with a nonenhancing central scar, a progressive complete enhancement, or complete arterial enhancement with washout [ 32 ]. Given the variable enhancement patterns, mass-forming ICC can mimic adenocarcinoma metastases and HCC, so tissue sampling is often needed to confirm the diagnosis.…”

“…Ducts may be dilated or narrowed, and this pattern is difficult to distinguish from benign strictures. Intraductal ICC has variable patterns of ductal dilation and stricture with or without papillary and/or polypoid intraluminal masses [ 32 ].…”

Role of cantharidin in the activation of IKKα/IκBα/NF‑κB pathway by inhibiting PP2A activity in cholangiocarcinoma cell lines

“…Cholangiocarcinoma (CC) is a malignant tumor originating from biliary epithelia within intrahepatic and extrahepatic tracts ( 1 , 2 ). Although the incidence of CC is rare globally, its prevalence and mortality rate is growing annually ( 2 ).…”